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China Kadoorie Biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up
Open accessAbstract
BACKGROUND: Large blood-based prospective studies can provide reliable assessment of the complex interplay of lifestyle, environmental and genetic factors as determinants of chronic disease. METHODS: The baseline survey of the China Kadoorie Biobank took place during 2004-08 in 10 geographically defined regions, with collection of questionnaire data, physical measurements and blood samples. Subsequently, a re-survey of 25,000 randomly selected participants was done (80% responded) using the same methods as in the baseline. All participants are being followed for cause-specific mortality and morbidity, and for any hospital admission through linkages with registries and health insurance (HI) databases. RESULTS: Overall, 512,891 adults aged 30-79 years were recruited, including 41% men, 56% from rural areas and mean age was 52 years. The prevalence of ever-regular smoking was 74% in men and 3% in women. The mean blood pressure was 132/79 mmHg in men and 130/77 mmHg in women. The mean body mass index (BMI) was 23.4 kg/m(2) in men and 23.8 kg/m(2) in women, with only 4% being obese (>30 kg/m(2)), and 3.2% being diabetic. Blood collection was successful in 99.98% and the mean delay from sample collection to processing was 10.6 h. For each of the main baseline variables, there is good reproducibility but large heterogeneity by age, sex and study area. By 1 January 2011, over 10,000 deaths had been recorded, with 91% of surviving participants already linked to HI databases. CONCLUSION: This established large biobank will be a rich and powerful resource for investigating genetic and non-genetic causes of many common chronic diseases in the Chinese population.
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“GWAS using siblings (within-sibship GWAS) (Fig. 2) have been previously limited by available data, but are now feasible by combining well-established family studies with recent large biobanks that incidentally or by design contain thousands of sibships35–39.”
From Within-sibship genome-wide association analyses decrease bias in estimates of direct genetic effects (2022) · cites this paper as [38]
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“Similar initiatives have been conducted in other countries, such as the China Kadoorie Biobank 86 and Biobank Japan 87 .”
From Multimodal biomedical AI (2022) · cites this paper as [86]
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“These biobank efforts, pioneered in studies such as the Framingham Cohort70 and the efforts of DeCODE in Iceland71,72, now encompass a growing inventory of national cohorts in North America, Europe, Asia and beyond73–76.”
From A brief history of human disease genetics (2020) · cites this paper as [76]
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Self-citationHan, Y., Lv, J., Yu, C., Guo, Y., Bian, Z., Hu, Y., Yang, L., Chen, Y., Du, H., Zhao, F., et al. (2021) · Breast Cancer Research · doi:10.1186/s13058-021-01439-2 · Cited by 18
“Methods Data for model development Data from the CKB, a large-scale prospective study, was used to derive the relative risk (RR) model [16].”
MethodSelf-citationAortic Dissection Incidence and Risk Factor Analysis: Findings from the China Kadoorie Biobank
Chen, D., Fang, K., Luo, M., Xiao, Y., Zhao, Y., & Shu, C. (2024) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2024.12.003 · Cited by 14
Puthur, C., Nabatte, B., Tinkitina, B., Kabatereine, N. B., & Chami, G. F. (2025) · BMJ Public Health · doi:10.1136/bmjph-2024-002151 · Cited by 14
Reproducible disease phenotyping at scale: Example of coronary artery disease in UK Biobank
Patel, R. S., Denaxas, S., Howe, L. J., Eggo, R. M., Shah, A. D., Allen, N. E., Danesh, J., Hingorani, A. D., Sudlow, C. L. M., & Hemingway, H. (2022) · PLoS ONE · doi:10.1371/journal.pone.0264828 · Cited by 13
“China Kadoorie Biobank [2], US Million Veterans Program [3], All of Us Research Program [4] and many others − offers unique opportunities to better understand genetic, lifestyle and environmental factors that underpin development of common complex conditions, such as coronary artery disease (CAD).”
BackgroundRodosthenous, R. S., Niemi, M., Kallio, L., Perälä, M., Terho, P., Knopp, T., Punkka, E., Makkonen, E., Nurmi, P., Mäkelä, J., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-064695 · Cited by 13
Fan, P., Zhang, S., Wang, W., Yang, Z., Tan, W., Li, S., Zhu, C., Hu, D., Zhou, X., Tian, Z., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.996169 · Cited by 14
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Self-citationGenetic underpinnings of cerebral edema in acute brain injury: an opportunity for pathway discovery
Kirsch, E. P., Szejko, N., & Falcone, G. J. (2020) · Neuroscience Letters · doi:10.1016/j.neulet.2020.135046 · Cited by 13
“Chen Z, et al., China Kadoorie Biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up.”
BackgroundInfluentialSun, Z., Hu, Y., Yu, C., Guo, Y., Pang, Y., Sun, D., Pei, P., Yang, L., Chen, Y., Du, H., et al. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac264 · Cited by 15
Self-citationWen, Q., Liu, T., Yu, Y., Zhang, Y., Yang, Y., Zheng, R., Li, L., Chen, R., & Wang, S. (2023) · Environmental Health Perspectives · doi:10.1289/ehp10486 · Cited by 14
Self-citationDong, W., Pan, X., Yu, C., Lv, J., Guo, Y., Bian, Z., Yang, L., Chen, Y., Wu, T., Chen, Z., et al. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.117.006595 · Cited by 14
“The vital status of each participant was obtained by linkage to China’s Disease Surveillance Points system, checked annually against local residential cards, health insurance records, and local street committees.(19) Scanned copies of original disease reporting cards and official death certificates were obtained for e…”
MethodSelf-citationZhang, L., Yang, C., Xiao, Q., Geng, G., Cai, J., Chen, R., Meng, X., & Kan, H. (2021) · Remote Sensing · doi:10.3390/rs13030397 · Cited by 14
“Suzhou is one of five urban locations in the China Kadoorie Biobank (CKB) cohort that have focused on common chronic diseases since 2004 [34].”
BackgroundNauman, J., Franklin, B. A., Nes, B. M., Sallis, R. E., Sawada, S. S., Marinović, J., Stensvold, D., Lavie, C. J., Tari, A. R., & Wisløff, U. (2022) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2021.10.022 · Cited by 13
on behalf of the China Kadoorie Biobank Collaborative Group, Shen, Z., Yu, C., Guo, Y., Bian, Z., Wei, Y., Du, H., Yang, L., Chen, Y., Gao, Y., et al. (2020) · Archives of Osteoporosis · doi:10.1007/s11657-020-00734-3 · Cited by 14
Self-citationHan, Y., Zhu, X., Hu, Y., Yu, C., Guo, Y., Hang, D., Pang, Y., Pei, P., Ma, H., Sun, D., et al. (2023) · JMIR Public Health and Surveillance · doi:10.2196/43725 · Cited by 13
Self-citationChun, M., Qin, H., Turnbull, I. J., Sansome, S., Gilbert, S., Hacker, A., Wright, N., Zhu, T., Clifton, D. A., Bennett, D., et al. (2023) · International Journal of Stroke · doi:10.1177/17474930231162265 · Cited by 13
Self-citationDice, A. L. E., Lawn, R. B., Ratanatharathorn, A. D., Roberts, A. L., Denckla, C. A., Kim, A. H., de la Rosa, P. A., Zhu, Y., VanderWeele, T. J., & Koenen, K. C. (2024) · BMC Medicine · doi:10.1186/s12916-024-03360-9 · Cited by 14
“Our group [118–120] and others [121–126] are working to expand genetic studies in non-European ancestry populations, which have been sorely underrepresented in such work.”
BackgroundNormal-weight obesity subtypes and 10-year risks of major vascular diseases in 0.3 million adults
Wang, M., Xu, K., Yang, J., Bennett, D., Du, H., & Liu, X. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.12.027 · Cited by 13
Hof, J. P., & Speed, D. (2025) · Nature Genetics · doi:10.1038/s41588-025-02286-z · Cited by 13
“Since the first GWAS was carried out in 2005, sample sizes have regularly increased, such that studies involving more than 100,000 individuals are now common 3–7 .”
Cicek, M. S., & Olson, J. E. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.00362 · Cited by 14
Snoring frequency and risk of type 2 diabetes mellitus: a prospective cohort study
Dai, N., Shi, Q., Hua, Y., Guo, Y., Bian, Z., Li, L., Chen, Z., Wu, M., & Lu, Y. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-042469 · Cited by 13
Self-citationArtificial Intelligence toward Personalized Medicine
Gifari, M. W., Samodro, P., & Kurniawan, D. W. (2021) · Pharmaceutical Sciences and Research · doi:10.7454/psr.v8i2.1199 · Cited by 13
Nie, J., for the China Kadoorie Biobank (CKB) Collaborative Group, Liu, C., Yu, C., Guo, Y., Pei, P., Yang, L., Chen, Y., Du, H., Zhu, K., et al. (2022) · Journal of Parkinson s Disease · doi:10.3233/jpd-223148 · Cited by 14
“The detailed information of the CKB and baseline [16,17].”
Self-citationSonti, S., & Grant, S. F. A. (2022) · SLEEP · doi:10.1093/sleep/zsac180 · Cited by 12
Yeung, S. L. A., Jiang, C. Q., Zhang, W. S., Lam, T., Cheng, K. K., Leung, G. M., & Schooling, C. M. (2013) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2013-202807 · Cited by 13
Peng, K., Yao, P., Kartsonaki, C., Yang, L., Bennett, D., Tian, M., Li, L., Yu, C., Bian, Z., Chen, Y., et al. (2019) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000001478 · Cited by 13
“Baseline Survey Details of the design and study procedures used in CKB have been previously published.(29) Briefly, 512,891 adults (210,222 men, 302,669 women) aged 30-79 years were recruited from 10 regions (5 urban, 5 rural) in China from 2004 to 2008.”
MethodSelf-citationAshraf, B. H., & Lawson, D. J. (2021) · European Journal of Human Genetics · doi:10.1038/s41431-021-00873-2 · Cited by 13
Yao, P., Mazidi, M., Pozarickij, A., Iona, A., Wright, N., Lin, K., Millwood, I. Y., Fry, H., Kartsonaki, C., Chen, Y., et al. (2025) · Stroke · doi:10.1161/strokeaha.125.050982 · Cited by 14
Self-citationPCSK9 genetic variants and risk of vascular and non-vascular diseases in Chinese and UK populations
Holmes, M. V., Kartsonaki, C., Boxall, R., Lin, K., Reeve, N. F., Yu, C., Lv, J., Bennett, D., Hill, M., Yang, L., et al. (2024) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwae009 · Cited by 13
“28 In brief, baseline information was collected via a laptop-based questionnaire (including demographic and lifestyle factors and medical history) and physical measurements (including anthropometry, blood pressure, and lung function).”
Self-citationChen, L., Xiong, H., Wen, Q., Lv, J., Sun, D., Pei, P., Yang, L., Chen, Y., Du, H., Li, L., et al. (2024) · Journal of Epidemiology and Global Health · doi:10.1007/s44197-024-00290-w · Cited by 12
“Vital status and cause of death were ascertained through reviews of official residential records and death certificates submitted to the local Center for Disease Control and Prevention (CDC), supplemented by medical records and validated verbal autopsy [15].”
MethodSelf-citationXia, X., Chan, K. H., Niu, Y., Liu, C., Guo, Y., Ho, K., Yim, S. H. L., Wang, B., Doherty, A., Avery, D., et al. (2024) · Environment International · doi:10.1016/j.envint.2024.109060 · Cited by 12
Self-citationLi, H., Lv, J., Yu, C., Guo, Y., Bian, Z., Fan, J., Yang, L., Chen, Y., Du, H., Long, H., et al. (2020) · American Journal of Epidemiology · doi:10.1093/aje/kwaa119 · Cited by 12
“Ascertainment of type 2 diabetes Cases of type 2 diabetes were ascertained by linking participants to local disease and death registries, starting from the time they enrolled in the study, and to the national health insurance system (14).”
BackgroundMethodInfluentialSelf-citationHee, J. Y., Huang, S., Leong, K. P., Li, C., Zhang, Y. O., Gongye, R., & Tang, K. (2022) · BMC Public Health · doi:10.1186/s12889-022-14163-z · Cited by 12
“Repeated sampling of selected items of the questionnaire and physical measurements was carried out at random in approximately 3% of participants from each community to ensure the quality of the data [22].”
BackgroundMethodInfluential
Metadata
- Authors
- Chen, Z., Chen, J., Collins, R., Guo, Y., Peto, R., Wu, F., Li, L., & on behalf of the China Kadoorie Biobank (CKB) collaborative group
- Affiliations
- Chinese Center For Disease Control and Prevention (CN)
- Corresponding author
- Chen, Z.
- Li, L.
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-09-21
- Volume
- 40
- Issue
- 6
- Pages
- 1652-1666
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC3235021
- OpenAlex
- W2105079646
- Cited by
- 1,034
- References
- 43
- Citations by year
- 2026: 109 · 2025: 122 · 2024: 134 · 2023: 110 · 2022: 107 · 2021: 116 · 2020: 75 · 2019: 66 · 2018: 55 · 2017: 51 · 2016: 30 · 2015: 26 · 2014: 14 · 2013: 12 · 2012: 6
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Epidemiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Wellcome Trust (088158/Z/09/Z)
- Cancer Research UK
- British Heart Foundation
- Chinese Center for Disease Control and Prevention
- Kadoorie Charitable Foundation
- Centers for Disease Control and Prevention
- Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Health, Environment, Cognitive Aging
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Keywords
- China Kadoorie Biobank, prospective cohort, biobanks, baseline characteristics, smoking prevalence, blood pressure, body mass index, diabetes prevalence, cause-specific mortality, hospitalization, chronic disease, Chinese adults
- MeSH terms
- Adult, Age Factors, Aged, Blood Pressure, Body Weights and Measures, China, Chronic Disease, Data Collection, Environment, Female, Follow-Up Studies, Genetic Testing, Humans, Life Style, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Residence Characteristics, Rural Population, Sex Factors, Smoking, Socioeconomic Factors, Health Behavior, Body Mass Index, Databases, Factual, Genetic Predisposition to Disease, Databases, Genetic
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